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From the Departments of *Cardiology, 
Emergency Medicine, 
Angiology, and 
University Library, Vienna General Hospital, Medical University, Vienna, Austria.
Address correspondence and reprint requests to Franz Wiesbauer, MD, MPH, Department of Internal Medicine II, Cardiology Unit, Vienna General Hospital, Medical University, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Address e-mail to franz.wiesbauer{at}meduniwien.ac.at.
BACKGROUND: Perioperative ß-blockers are suggested to reduce cardiovascular mortality, myocardial–ischemia/infarction, and supraventricular arrhythmias after surgery. We reviewed the evidence regarding the effectiveness of perioperative ß-blockers for improving patient outcomes after cardiac and noncardiac surgery.
METHODS: Eleven large databases were searched from the time of their inception until October 2005. Various online-resources were consulted for the identification of unpublished trials and conference abstracts. We included randomized, controlled trials comparing perioperative ß-blockers with either placebo or the standard-of-care. Of the 3680 retrieved titles, 69 met inclusion criteria for analysis. Odds ratios (OR) assuming random effects were computed in the absence of significant clinical heterogeneity.
RESULTS: ß-Blockers reduced the frequency of ventricular tachyarrhythmias [OR (cardiac surgery): 0.28, 95% CI 0.13–0.57; OR (noncardiac surgery): 0.56, 95% CI 0.21–1.45], atrial fibrillation/flutter [OR (cardiac surgery): 0.37, 95% CI 0.28–0.48], other supraventricular arrhythmias [OR (cardiac surgery): 0.25, 95% CI 0.18–0.35; OR (noncardiac surgery): 0.43, 95% CI 0.14–1.37], and myocardial ischemia [OR (cardiac surgery): 0.49, 95% CI 0.17–1.4; OR (noncardiac surgery): 0.38, 95% CI 0.21–0.69]. Length of hospitalization was not reduced [weighted mean difference (cardiac surgery): –0.35 days, 95% CI –0.77–0.07; weighted mean difference (noncardiac surgery): –5.59 days, 95% CI –12.22–1.04] and, in contrast to previous reports, ß-blockers did not reduce mortality [OR (cardiac surgery): 0.55, 95% CI 0.17–1.83; OR (noncardiac surgery): 0.78, 95% CI 0.33–1.87], and they had no influence on the occurrence of perioperative myocardial infarction [OR (cardiac surgery): 0.89, 95% CI 0.53–1.5; OR (noncardiac surgery): 0.59; 0.25–1.39].
CONCLUSIONS: ß-Blockers reduced perioperative arrhythmias and myocardial ischemia, but they had no effect on myocardial infarction, mortality, or length of hospitalization.
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